Summaries for Patients|19 May 2015

A Value Framework for Cancer Screening
Free

The full report is titled “A Value Framework for Cancer Screening: Advice for High-Value Care From the American College of Physicians.” It is in the 19 May 2015 issue of Annals of Internal Medicine (volume 162, pages 712-717). The authors are R.P. Harris, T.J. Wilt, and A. Qaseem, for the High Value Care Task Force of the American College of Physicians.

Summaries for Patients are a service provided by Annals and the ACP Center for Patient Partnership in Healthcare to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

What is the problem and what is known about it so far?

Screening tests are often used to find cancer, usually before there are symptoms. There are many different options for cancer screening that vary in intensity (how many people are screened and how powerful the screening tests are). Some high-intensity screening strategies aim to screen large amounts of people more often. These high-intensity strategies can be low-value because they come with greater harms and higher costs but not much more benefit.

How did the ACP develop this advice?

The authors looked at research studies on cancer screening strategies and the tradeoffs between benefits from cancer screening versus related harms.

What does the ACP recommend that patients and doctors do?

To help better understand how to measure value in screening tests, the ACP recommends 5 concepts to consider in making decisions about whether screening tests are right for you.

• Concept 1: Screening is not always a single test. One screening test can set off a chain of more tests that may lead to benefit or harm. Many patients will need to have follow-up testing. Patients with true-positive results (results that show cancer) will benefit from these tests. However, patients with false-positive results (results that show cancer that does not exist or does not need treatment) may have more harms and costs.

• Concept 2: Not all cancer cases are the same. The best screening strategies look to find cancer that will respond to early treatment. Some cancer grows very slowly and may never cause symptoms. If this type of cancer is found during screening, a patient will experience more harms than benefits. Screening is only worthwhile when it finds cancer that will benefit from early treatment.

• Concept 3: Not all patients are the same. The best screening strategies focus on patients who will benefit from early detection and treatment. Some patients in good general health will benefit from cancer treatment and will live longer. Other patients may not get any benefit from cancer treatment because they will not live longer due to other health problems.

• Concept 4: Although screening leads to important benefits for some cancer types and some people, it can also lead to significant harms for many more people. If a patient has a true-positive result, the screening test can benefit the patient by leading to early treatment and improving outcomes. For others, there may be no benefits but serious harms. These harms include the possibility of tests that may cause pain, anxiety about test results, and added costs. For some people, just because cancer is found early, it does not mean their lives will be extended.

• Concept 5: Determining the value of screening strategies is complex but not impossible. The number of people harmed in some way by screening is always larger than the number of deaths prevented by screening. However, the benefit of saving or extending a person's life is great and can often outweigh the harms that some people experience.

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.